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Overview of anxiety in palliative care

Scott A Irwin, MD, PhD
Jeremy M Hirst, MD
Section Editor
Susan D Block, MD
Deputy Editors
Diane MF Savarese, MD
Richard Hermann, MD


For most patients in palliative care, symptoms of anxiety are normal and are expected consequences given the uncertainties of living with serious illness and the possibility of approaching death. Anxiety is generally described as a feeling of helplessness or fear, often related to a sense of losing control that frequently accompanies life with illness, as well as being generated by death-related factors. A patient’s distress may also be related to physical, psychological, social, spiritual, practical, end of life, and loss issues [1,2]. They express fears about what their death will look and feel like and what events will lead up to it. They frequently voice concerns about religious beliefs, spiritual issues, existential matters, or how to achieve a good death. Some people with anxiety may require intervention and some may not. Often reassurance, presence, addressing their concerns directly, and controlling symptoms is all that is needed.

While many patients with serious illness have worries, fears, and apprehensions, they do not usually rise to the level of an anxiety disorder. That is, anxiety disorders should not be assumed to be an inevitable part of serious illness [3]. However, for other patients symptoms of anxiety can be severely debilitating and require intensive treatment. At the most extreme, out of control anxiety can sometimes lead to a heightened interest in a hastened death [1].  

The detrimental impact of untreated, persistent anxiety was demonstrated in one multicenter study of over 600 patients with advanced cancer that evaluated associations between anxiety disorders and multiple endpoints, including physician-patient relationships [4]. Patients with anxiety disorders had less trust in their clinicians compared to those without anxiety. In addition, patients with anxiety reported being:

Less comfortable asking questions about their health

Less likely to understand the clinical information

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Literature review current through: Nov 2017. | This topic last updated: May 10, 2017.
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